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The Standard SI 1648: Individual Disability APS

The Standard's individual disability income claim packet contains an Attending Physician's Statement that the treating physician completes to show whether the patient's condition is disabling. Part B covers diagnoses and ICD codes, vitals, history and hospital stays, the date the physician advised stopping work, physical and mental impairment classes, treatment and medications, possible job modifications, and the expected course and return-to-work date.

Who completes it

The patient completes Part A of the statement; the physician completes Part B and signs with taxpayer ID. The insured also completes the Insured's Statement and signs the authorizations in the same packet.

Submitting and payment

How to submit it
The physician mails the completed statement directly to The Standard's Individual Disability Benefits office; the packet header also lists a fax line.
Who pays
Part B states the patient is responsible for completion of the form without expense to The Standard.

Good to know

  • The packet asks that every space be filled in, with NA where a question does not apply, and Part B warns that forms may be returned for unanswered questions.
  • If the patient has seen more than one physician for the disability, each completes a separate statement; additional forms can be requested from The Standard.
  • Section 1 flags whether the condition relates to employment, a mental disorder, alcohol or drugs, or pregnancy, with expected and actual delivery dates and complications.
  • Edition SI 1648 (2/25). New York policies use SNY 1648, and SI 6935 is an optional authorization to release information.

Get the official form

Download the current version from the source each time; forms change without notice.

Individual Disability Benefits Claim Packet (Attending Physician's Statement)

Official pagePDF

How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

What impairment classes does The Standard's SI 1648 use?

The physician picks a physical impairment class from 1, no limitation and capable of heavy work, to 5, unable to do even sedentary activity, each with a percentage range. A parallel mental impairment scale runs from Class 1, no limitations, to Class 5, severe limitations.

What attachments does The Standard want with SI 1648?

Part B asks for laboratory data and results of special tests such as X-rays, CT scans and EKGs, plus copies of pertinent surgical reports, hospital admitting history, discharge summaries, chart notes and narrative reports, so The Standard can document functional impairment.

What does the SI 1648 prognosis section ask?

Section 5 asks whether the condition has recovered, improved, stayed unchanged or regressed since onset, when a marked change is expected, and when the patient can return to work. If the physician cannot tell, the form allows a reason and a follow-up interval in months.